Promoting Ghanaian Herbal Medicine (GHM) in the Fight against the Covid-19 Pandemic

A deadly infectious disease of unknown etiology earlier referred to
as ‘Wuhan pneumonia’ was reported in Wuhan city of the Peoples Republic
of China in December 2019, and by January 7, 2020, it was confirmed as a
new type of coronavirus called “Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2)”.

In February, 2020, the World Health Organization (WHO) named the
pneumonia as Coronavirus Disease 2019 (Covid-19). The sudden and rapid
unexpected spread of Covid-19 from China to several other countries
compelled the WHO to officially declare a global pandemic on March 11,
2020. People infected with SARS-CoV-2 usually show respiratory symptoms
of cough, fever and lung damage, and other related two conditions such
as fatigue, myalgia and diarrhea.

As of April 29, 2020, a total of 1,671 cases of SARS-CoV-2 infections
had been confirmed and reported in Ghana, and over 3,100,000 cases
across the globe. The reported cases continue to rise because of the
rapid spread of SARS-CoV-2 via human-to-human transmission. The
SARS-CoV-2 is an enveloped single stranded RNA-type beta-coronavirus and
its genome sequences shared 79.5% sequence identity to severe acute
respiratory syndrome-related coronaviruses (SARS-CoV) [1].

The Covid-19 can be diagnosed by either laboratory testing (real-time
Reverse Transcription Polymerase Chain Reaction, rRT-PCR; Enzyme-linked
immunosorbent assay, ELIZA) or chest computed tomography scan (CT
scan), but sadly, as of now, there are no approved specific antiviral
drugs or vaccines available for its treatment or prevention. The general
case management/treatment and prevention plans globally involve
supportive care, hygienic practices, lifestyle modification and healthy
diet.

The present clinical protocols for Covid-19 treatment in Ghana are
solely orthodox and are yet to fully incorporate Ghanaian Herbal
Medicine (GHM) regimen. It is expected that in the wake of Covid-19
pandemic, mandatory institutions, such as the Centre for Plant Medicine
Research (CPMR), Traditional and Alternative Medicines Directorate
(TAMD), Ghana, Food and Drugs Authority (FDA), Ghana Federation of
Traditional Medicine (GHAFTRAM) and medicinal plants and natural product
drug discovery experts in research institutions across Ghana would team
up to develop a concerted framework and suitable natural product
remedies towards integration of GHM into both current and future
therapeutic options for the management/treatment of Covid-19.

Ghana is endowed with experienced and accomplished researchers in
medicinal plant and natural product resources across universities and
research institutes. In addition, the country has a rich diversity of
medicinal plants with a large group of herbal and folk medicine
practitioners.

Therefore, collaborative effort in harnessing the diverse expertise,
scientific knowledge and anecdotal reports of the teams earlier
mentioned can provide the required synergies to make strides in the
discovery and development of plant medicine against Covid-19. It is
considered that the time to act is now!

Ethnobotanical and pharmacological studies on some indigenous medicinal plants (Paullinia pinnata, Solanum torvum, Alstonia boonei, Sutherlandia frutescens,Celtis mildbraedii, Acacia kameruneensis)
have effectively been used to treat a plethora of viral infections such
as common cold, pneumonia, measles, small pox, hepatitis and human
immunodeficiency virus (HIV) in Ghana [2-5].

Unfortunately, the clinical application of these potential antiviral
medicinal plants has not been sufficiently explored partly due to lack
of standardized product development and reasonable scientific data on
traditional formulations to support safety and efficacy in humans.
However, studies have demonstrated that the aforementioned medicinal
plants are capable of preventing or destroying viral replication.

The objective of this write up therefore is to sensitize a national
discourse on the development and use of standardized herbal medicines as
complementary therapy in public health diseases including Covid-19. For
this purpose, the experience of China (home of traditional medicine) in
the development of traditional medical practice and the therapeutic
benefits of herbal medicines can inform a national strategic agenda
towards the effective integration of GHM into the health delivery
system.

As earlier mentioned, the main treatment protocol for Covid-19 has
been a supportive care package, which includes the combination of
broad-spectrum antibiotics, antivirals, corticosteroids and convalescent
plasma [6]. HIV protease inhibitors such as ritonavir and lopinavir
have also been used, and very often in combination with other
appropriate antibiotics to treat Covid-19 patients [7, 8].

Nucleoside analog, favipiravir (T-705) has demonstrated to
effectively inhibit the activity of RNA polymerase of RNA viruses such
as influenza [9]. A recent report revealed that favipiravir had
significant in vitro anti-SARS-CoV-2 activity [10], but the in vivo effect
remains elusive. It has been reported that remdesivir may be the most
promising antiviral drug for treating Covid-19 since it has both in vitro and in vivo antiviral
activity against a wide array of RNA viruses including SARS, Middle
East respiratory syndrome (MERS) [11], and Ebola virus, and could
decrease viral loads and pathology of lungs in animal models [12].

Currently, it is under clinical trial to evaluate the safety and
efficacy of intravenous remdesivir for patients with SARS-CoV-2
infection. Similarly, host-targeted small molecules approved for other
human diseases may modulate the virus-host interactions of SARS-CoV-2.
Recently, hydroxychloroquine/chloroquine, a potential broad-spectrum
antiviral drug [13,14], demonstrated anti-SARS-CoV-2 activity [10],
however, a preliminary study on its use on Covid-19 patients in the US
revealed 16.4% higher death rate than in control patients [15].

The aforementioned data support the assertion by the World Health
Organization (WHO) that there is currently no specific recommended
medicine for the prevention or treatment of Covid-19. In this regard,
there is a great opportunity for Ghana to explore the immense potential
of GHM as a complementary therapy for Covid-19 patients. There is no
gainsaying the fact that some Ghanaians might have started using GHM as
treatment option for complaints consistent with Covid-19 symptoms with
some success.

It is therefore time for researchers, herbal medical practitioners,
regulators, other relevant scientists, the private sector and policy
makers to come on board to valorize medicinal plant research and plant
resources in order to find local solutions with global impact for
treatment of Covid-19 in Ghana. This clarion call is underpinned by the
success story of medicinal plant products utilization in the treatment
of Covid-19 in China [16].

The Chinese have been pacesetters in the use of natural products in
treating deadly coronavirus diseases such as SARS, MERS and Covid-19.
The Health Commission in 26 provinces of China has officially declared
that Traditional Chinese Medicine (TCM) should be used in combination
with conventional medicine therapies for Covid-19 patients [16]. In
February 2020, the National Health Commission (NHC) of China also
reported that 60,107 confirmed Covid-19 patients (85.20% of total
confirmed cases) had been treated with TCM [17].

As of March 1, 2020, a total of 303 ongoing clinical trials aimed at
evaluating the efficacy and safety of treatments for Covid-19 patients
had been launched in China with 50 of the trials (16.5%) assessing TCM
[16]. According to the report of the National Administration of
Traditional Chinese Medicine, by February 5, 2020, over two-hundred
(214) Covid-19 patients had been treated with a polyherbal formulation (Qing Fei Pai Du Tang) in Shanxi, Hebei, Heilongjiang and Shaanxi Provinces with excellent efficacy (≥ 90%) [18].

Over the years, natural products continue to provide antiviral agents
that selectively kill the pathogenic organism in the presence of other
living organisms. There are sufficient biochemical differences that
exist between the metabolism of bacterial and mammalian cells that
enable selectivity to be achieved, leading to the early development of
antibacterial agents, which were safe for clinical application. However,
viruses, despite their apparent simplicity, present a challenging
situation in anti-viral drug design efforts due to their replicative
cycle.

In this replicative cycle, viruses become physically and functionally
incorporated into the host cells. Consequently, it becomes very
difficult to distinguish unique biochemical features of the pathogen
from the host cell to serve as drug targets for selective activity. The
competitive advantage in using antiviral medicinal plants is enshrined
in their multitarget and broad-spectrum activities which include
attacking the viral components (envelop, nucleic acid and proteins) and
viral life cycle (entry, replication, assembling and release) [19].
These medicinal plants may also stimulate the defense mechanism of the
host via their immunomodulation, antioxidant, antiinflamatory and
bronchodilatory properties in destroying the deadly viruses.

There are sufficient scientific data to show that antiviral Ghanaian
medicinal plants possess such mechanistic features which can be
unearthed to combat Covid-19. It is possible that some biomedical
natural product scientists have already commenced investigation into the
effect of GHM products or its components on SARS-CoV-2 in the
laboratories. The diverse research efforts towards Covid-19 should be
brought to a common platform by policy makers and stakeholders in order
to have a unified direction and purpose for optimal utilization of
research funds, research infrastructure and social uptake of research.

This therefore places a call on the government to consider
substantial research support to interdisciplinary research teams in
terms of funds and material resources in its ‘Covid-19 combat plan’ for
now and the future. For a start, the government can dedicate 5% -20% of
the proceeds of the Covid-19 National Trust Fund to Covid-19 priority
research needs and invite applications from local interdisciplinary
research teams in collaboration with CMPR and FDA, Ghana. In a couple of
months, it is envisaged that outstanding indigenous polyherbal
medicines suitable for clinical trials would be developed as antiviral
agents for the treatment of Covid-19 patients.